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The mobile rib plaque is a very serious injury to the thoracic cavity, which is a surgical emergency; Common after a very strong trauma. causing severe respiratory and circulatory disorders.
1. What is a mobile rib array?
The movable rib plate is the area of the chest wall that is no longer continuous with the ribcage, due to the loss of stability of the skeleton. The movable rib array is only present when at least 3 adjacent ribs are broken, and broken at both ends, and the fracture foci at each end must be in the same line. Because the ribs are broken at both ends, the stability of the skeleton is lost, thereby causing many respiratory disorders. Movable costal plaques are most common at the lateral costal plate sites, and clinical manifestations will also be most obvious. Other locations where the movable costal array may be encountered are the sternolateral and posterior lateral costal plates.
Mảng sườn đi động (Hình ảnh minh họa)
2. Why is the movable rib array an emergency?
When there is a moving rib array, severe respiratory disorders will appear, originating from the following phenomena:
2.1 Respiratory reversal The pressure in the pleural cavity decreases, the costal plate is pulled inward, pressing on the lateral lung injury, pushing some air back up the trachea and into the healthy lung.
The above phenomenon happens in the opposite direction, resulting in the appearance of an amount of gas that only circulates in the airways, completely not participating in gas exchange, leading to a decrease in tidal volume, limiting inhibit gas exchange in the lungs.
2.2 Mediastinal swaying Inhaling, the movable rib plate will press on the affected lung, causing the mediastinum to be displaced to the healthy lung. Exhaling, the lung on the injured side is no longer pressed by the movable rib plate, the mediastinum is no longer displaced and will move backwards.
The mediastinum is constantly shifted back and forth, causing irritation of the reflex centers of the heart and lungs and causing the large blood vessels in the heart to twist. From there, it leads to a series of serious circulatory disorders that result in respiratory arrest or reflex cardiac arrest.
Due to the lack of oxygen, the patient will try to breathe faster, and the faster he breathes, the stronger the two phenomena above will become, forming a pathological spiral.
Trung thất dịch chuyển có thể gây ra nhiều ảnh hưởng nghiêm trọng tới tim
3. Signs of identifying mobile ribs
When the movable rib plate appears, when the patient breathes in, the area of the rib plate can be seen to be concave (inward suction), while when the patient exhales, this rib area is inflated (when breathing in the rib cage). ribs always move in the opposite direction to the thorax).
4. Treatments for movable ribs
When a movable rib array appears, the first thing that needs to be done on the spot is first aid in order to make the patient's movable rib plate no longer mobile. Fixation of the movable rib array can be done by simple methods, such as inserting a cotton pad (or sufficient sandbag) on the position of the movable rib array and then wrapping it around the fixed chest, leaving the patient in the upright position. lying position on the movable rib array.
Sơ cứu cố định mảng sườn di động tại chỗ
The patient's ribs will always remain in a concave position without inflating, helping to prevent circulatory and respiratory disturbances (although breathing will be partially limited).
True treatment of movable ribs can be done by external fixation or internal fixation (by mechanical ventilation), but external fixation is the most commonly used method. External fixation can be performed in the following ways:
Metal rib fusion Surgery Continuous traction of the rib plate (usually applied to the sternum rib) Stitch fixation of the rib plate on the frame Stitch fixation of broken ribs with Besides the treatment of the mobile rib array, the patient will be treated with accompanying injuries (if any), such as hemothorax in the pleural space, pneumothorax, ...
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